Vehicle extrication - are we moving too fast?

Published:  19 September, 2014

“I feel the need. The need for_______.”

Most people can quote this famous line from Tom Cruise’s 1986 hit movie Top Gun.  But for purposes of discussion, I left off the last words.  I did this because when it comes to today’s vehicle extrication process we need to think about what is the best word or words we should be putting there.  Maybe “speed” is not the proper word in the vehicle rescue environment today.  Maybe we should be thinking that slower may be better?

What sparked my thoughts on this topic was a recent conversation I had with a long-time friend and fellow rescuer.  We were “talking shop” and the conversation turned to our mutual concerns related to the increased number of battery-powered hydraulic and other time-saving rescue tools that are out in the streets today.

Before I go any further this is not intended to be a knock on any of the rescue tool manufacturers.  They have developed various tools to respond to the market demand of their customers.  Today, we have some of the best tools for extricating trapped victims and continue to see improvements and new developments that will aid rescuers in their job.

However, one concern I have with all of these advancements is whether we are becoming too fast at vehicle extrication scenes.

Before the advent of many of today’s newer extrication tools, a crew arriving at an accident scene needed a few minutes to get their hydraulic and/or other tools assembled and operational.  Depending on their organization’s equipment set up and standard operating guidelines, they had to assemble the tools, pull off the hydraulic hoses, electric cords, or compressed air supplies and move everything towards the vehicle in preparation to move metal.  During the time it took to set up the tools, (hopefully) the scene was being properly assessed, identified hazards were being controlled, and the vehicle itself was being stabilized and assessed.  Rescuers had a few moments to mentally evaluate the tasks and think about how best to approach the scenario. 

Fast forward to today.  Rescuers can pull into the scene and come right off a rescue truck and run up to the vehicle with fully functional untethered tools.  In a matter of seconds, they can be turning a vehicle into Swiss cheese.  This is great from the speed point of view and some will argue that with today’s staffing issues this is necessary.  I have to disagree.

At vehicle accidents today, rescuers need to slow down.  What?  Yep, I just said rescuers need to slow down.  This statement obviously goes against everything you have ever been taught in the past.

Modern vehicle technology is one reason why we need to slow the vehicle rescue process.  Today, I still see far too many times when rescuers walk up to a car and blindly start cutting, bending, prying, etc.  This occurs whether they have traditionally powered tools or battery-powered tools. 

Don’t believe me?  Get a car to practice on and simply tell your crew to go out and cut it apart.  Now watch and see how your crew performs, maybe even video the activity.  Do they assess the vehicle completely?  Are they ensuring that the vehicle has been properly stabilized and fully depowered?  Have they identified SRS locations?  Or are they just blindly cutting, bending, prying, breaking, etc?

If rescuers are not properly assessing the vehicle for alternative energy components, supplemental restraints, or other vehicle components before actual disentanglement and extrication efforts begin, could this potentially affect their operations?  If vehicles are not properly assessed, something bad will happen – maybe not this rescue or the next, but eventually it will.

Another similar reason for us to slow down is that cars are getting tougher to cut.  By now, hopefully every rescuer has heard about ultra-high strength steels, and the difficulties they pose for rescuers today.  Some of the tried and true techniques for moving or cutting metal no longer work.  Many times today, rescuers have to resort to alternate techniques to affect extrications.

If rescuers are coming right of the truck and going to work cutting or bending, have they taken the time necessary to analyze various options?  In some cases doing A before B works, but in many more cases today plan C works better than plan B, but only if you purposely skip plan A.  If crews are not evaluating the damage and deformation to the vehicle before they begin working they may end up having to work harder to complete the extrication in the long run.

The final (and what should be the most compelling) reason to slow down is our victim(s).  I know, that comment flies in the face of the “golden hour” concept (or “golden period” if you are so inclined).  We have literally been taught since the 1970s that we need to rip the victim out of the car, perform an extensive amount of on-scene interventions, and then literally airmail [sic] them to a trauma centre within 60 minutes of an accident or they are going to die.

Fast forward to today. Have you looked at the currently emerging trends in trauma patient management?  If no, maybe you should.  Then think about this; are we actually seeing as many “true trauma” patients at vehicle accidents today as we did in the past?  How many times today are we just popping a door so someone can get up and out of the vehicle and ultimately refuse any medical care or other assistance?

Today we should be assessing and treating our patients based upon their injuries, not a pre-determined notion that everyone in a car accident will die if we do not rip them out of a car as quickly as possible.  We need to stop and take the appropriate amount of time necessary to complete a proper assessment of the patient, BEFORE we go cutting, bending or prying.  If we do not, how do we actually know what rescue evolutions are necessary based on the patient’s condition.  Are we going to remember to do this when we go running to the car with tools already in hand?

Now I know some of you are thinking you do not have to worry about that since they are not doing patient care.  “That is the EMT’s or paramedic’s job.”  If that is your opinion, I think you need to seriously re-evaluate whether you want to be a rescuer or just somebody that wants to play with tools.

At this point, you are asking, or probably just assuming, that “the author has lost it”.  I am telling you to slow down.  This completely contradicts everything you have probably been taught about vehicle extrication.  I will be the first one to agree that time is still of the essence, however we need to take the appropriate amount of time to properly assess and evaluate the scene, the vehicle, and the victim before perform any significant evolutions.  Failing to do so could cause us to miss critical assessment and rescuer safety points and ultimately have detrimental or even disastrous, effects to the entire rescue operation. 

As I alluded to earlier in this article, we have some of the best and most efficient tools available to us today, the key is using them in a manner that creates the safest and most efficient extrication scene for both rescuers and victims.  This is not about a race; it is about patient-oriented vehicle rescue.

The author

Eric J. Rickenbach ("EJR") is a 30-year veteran of the volunteer emergency services from Rehrersburg, Pennsylvania (USA). He is a rescue instructor specializing in vehicle rescue, with particular interest in new car construction, energy, and safety systems. In addition to teaching and research, Eric is active in several vehicle rescue-related committees.

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